The TESLA Trial: Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke

Inclusion Criteria: 1. 18 to 85 years of age 2. Presenting with symptoms consistent with an acute ischemic stroke 3. Imaging evidence of an anterior circulation occlusion of the Internal Carotid Artery (ICA) terminus and/or Middle Cerebral Artery Main Stem (MCA M1) segment 4. NIHSS score \>6 at the time of randomization 5. Ability to randomize within 24 hours of stroke onset 6. Pre-stroke mRS score 0-1 7. Ability to obtain signed informed consent Imaging evidence of moderate-large infarct defined as: 1\. NCCT ASPECTS 2-5 Exclusion Criteria: 1. Females who are pregnant, or those of child-bearing potential with positive urine or serum beta Human Chorionic Gonadotropin (HCG) test 2. Known severe allergy (more than a rash) to contrast media uncontrolled by medications 3. Refractory hypertension (defined as persistent systolic blood pressure \>185 mmHg or diastolic blood pressure \>110 mmHg) 4. CT evidence of the following conditions: * Midline shift or herniation * Evidence of intracranial hemorrhage * Mass effect with effacement of the ventricles 5. Computed Tomography Angiography (CTA) evidence suggestive of difficult endovascular access per the treating interventionalist 6. Presence of cervical ICA occlusion (e.g., related to atherosclerotic disease or dissection) 7. Rapidly improving neurological status prior to randomization to NIHSS \<6 8. Bilateral strokes or multiple intracranial occlusions 9. Intracranial tumors 10. Known hemorrhagic diathesis, coagulation factor deficiency, or on anticoagulant therapy with an International Normalized Ratio (INR) of \>3.0 or Partial Thromboplastin Time (PTT) \>3 times of normal 11. Baseline platelet count \<30,000 per microliter (µl) 12. Life expectancy less than 90 days prior to stroke onset 13. Participation in another randomized clinical trial that could confound the evaluation of the study 14. Any other condition (in the opinion of the site investigator) that precludes an endovascular procedure or poses a significant hazard to the patient if an endovascular procedure was performed